title: Sharing experiences: towards an evidence based model of dengue surveillance and outbreak response in Latin America and Asia.
abstract: BACKGROUND
  The increasing frequency and intensity of dengue outbreaks in endemic and non-endemic countries requires a rational, evidence based response. To this end, we aimed to collate the experiences of a number of affected countries, identify strengths and limitations in dengue surveillance, outbreak preparedness, detection and response and contribute towards the development of a model contingency plan adaptable to country needs.
  
  
  METHODS
  The study was undertaken in five Latin American (Brazil, Colombia, Dominican Republic, Mexico, Peru) and five in Asian countries (Indonesia, Malaysia, Maldives, Sri Lanka, Vietnam). A mixed-methods approach was used which included document analysis, key informant interviews, focus-group discussions, secondary data analysis and consensus building by an international dengue expert meeting organised by the World Health Organization, Special Program for Research and Training in Tropical Diseases (WHO-TDR).
  
  
  RESULTS
  Country information on dengue is based on compulsory notification and reporting ("passive surveillance"), with laboratory confirmation (in all participating Latin American countries and some Asian countries) or by using a clinical syndromic definition. Seven countries additionally had sentinel sites with active dengue reporting, some also had virological surveillance. Six had agreed a formal definition of a dengue outbreak separate to seasonal variation in case numbers. Countries collected data on a range of warning signs that may identify outbreaks early, but none had developed a systematic approach to identifying and responding to the early stages of an outbreak. Outbreak response plans varied in quality, particularly regarding the early response. The surge capacity of hospitals with recent dengue outbreaks varied; those that could mobilise additional staff, beds, laboratory support and resources coped best in comparison to those improvising a coping strategy during the outbreak. Hospital outbreak management plans were present in 9/22 participating hospitals in Latin-America and 8/20 participating hospitals in Asia.
  
  
  CONCLUSIONS
  Considerable variation between countries was observed with regard to surveillance, outbreak detection, and response. Through discussion at the expert meeting, suggestions were made for the development of a more standardised approach in the form of a model contingency plan, with agreed outbreak definitions and country-specific risk assessment schemes to initiate early response activities according to the outbreak phase. This would also allow greater cross-country sharing of ideas.
authors.affiliation: Department of Paediatrics, University of Oxford, Oxford, UK. sb470@doctors.org.uk
authors.forename: Shiraz
authors.initials: S
authors.lastname: Badurdeen
authors.forename: David Benitez
authors.initials: DB
authors.lastname: Valladares
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
authors.forename: Ernesto
authors.initials: E
authors.lastname: Gozzer
authors.forename: Axel
authors.initials: A
authors.lastname: Kroeger
authors.forename: Novia
authors.initials: N
authors.lastname: Kuswara
authors.forename: Silvia Runge
authors.initials: SR
authors.lastname: Ranzinger
authors.forename: Hien Tran
authors.initials: HT
authors.lastname: Tinh
authors.forename: Priscila
authors.initials: P
authors.lastname: Leite
authors.forename: Yodi
authors.initials: Y
authors.lastname: Mahendradhata
authors.forename: Ronald
authors.initials: R
authors.lastname: Skewes
authors.forename: Ayesha
authors.initials: A
authors.lastname: Verrall
mesh_terms: D001208:Asia / Q000453:epidemiology; D003715:Dengue / Q000453:epidemiology*; D004196:Disease Outbreaks; D019317:Evidence-Based Medicine; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D015233:Models, Statistical; D011159:Population Surveillance / Q000379:methods; D018570:Risk Assessment